Discussing Dizzy Spells

Dr. Harold Gunatillake FRCS, Cosmetic Surgeon

VERTIGO AND DIZZINESS: I am sure that some percentage of readers of this article would have had one or more attacks of vertigo (spinning) at some stage in their lives. It is on record that 40 percent of Americans do suffer from benign paroxysmal positional vertigo (BPPV).

These attacks involve brief episodes of intense dizziness when you change the position of your head. Your surroundings appear to be moving either vertically or horizontally.

This invariably occurs whilst turning your neck in bed, and rarely whilst standing completely still, walking or in the sitting position. Some people feel that they are actually spinning. The effect may be slight and only just noticeable, or it may be so severe that you fall to the ground.

The condition is more common among the older people, mostly men than in women. Everyday activities like turning in bed, looking up or bending forward, especially if performed quickly, will trigger vertigo, often nausea and occasionally vomiting.

BPPV can come in bouts lasting several days to many months. It may resolve for no apparent reason only to return again at some time in the future.

The condition does not respond to medication like Serc, Stugeron and stemetil, though they may give relief from nausea and general malaise. These medications themselves can have side effects and driving a car or working on machinery is harmful.

Vertigo is more severe than dizziness, which is often experienced as a feeling of light-headedness when you stand up.

Mild vertigo is very common and symptoms are not serious. It is not a disease. However, recurrent or persistent vertigo could be caused by an underlying condition. You should see your GP to rule out a more serious cause and to get treatment.

This problem results from a problem with the nerves and structures of balance mechanism in your inner ear (vestibular labrynth).

It occurs when calcium carbonate particles normally contained in a sac called utricle gets lose and fall into the wrong part of the three canals of the inner ear, producing an episode of dizziness.

As these crystals move about inside the inner ear, they distort the information generated by this system to the brain. The result is a disruptive dizzy sensation of short duration.

These three canals positioned in different directions, are called Semicircular canals because of its shape. They communicate with the vestibule, which is a part of the vestibular labrynth.

Fortunately there is a simple way to treat this condition by self to relieve the symptoms, such as spinning and dizziness.

The crystals, which cause the distorted information, are relocated within the system to a section (utricle) where they do not move and therefore no longer cause the disturbance for a while. The manoeuvre is called the canalith repositioning procedure.

The doctor, or the physiotherapist, in the office, demonstrates this. This procedure consists of several simple head manoeuvres.

As mentioned the goal is to move particles from the fluid filled semicircular chambers of your inner ear into tiny bag-like structure (utricle) where these particles don't cause trouble or will be reabsorbed by fluids of your body. Each manoeuvre is held for about 30 seconds.

Canalith repositioning procedure

(Courtesy: Mayo Foundation for Medical Education and Research)

Step 1

First, you move from a sitting to a reclining position. Your doctor will help extend your head over the edge of the table at a 45-degree angle.

Step 2

Next, with your head still extended over the edge of the table, your doctor will prompt you to turn your head to the right about 90 degrees.

Step 3

Next you roll onto your side. Your head should be slightly angled while you look down at the floor.

Step 4

Finally, you return carefully to a sitting position and then tilt your head down. After the procedure, you must keep your head upright for 48 hours, even as you sleep. This allows time for the particles floating in your vestibular labrynth to settle into your utricle or be reabsorbed by your body fluids.

You may need to wear a neck collar to prevent tilting your head. It may be necessary to repeat the procedure several times.

These manoeuvres may bring about sensation of vertigo, and discomfort, but should not cause pain.

The next 48 hours is crucial. Keep the head upright most of the time. Continue to be cautious and try not to perform the activities, which cause the vertigo. When reclining, keep the trouble ear on top. (When you turn your head during above manoeuvres you will notice that the vertigo triggers only when moving to the side of the trouble ear.)

Use several pillows. Do not lie flat. Move slowly and not into positions which normally cause vertigo. Again, this is necessary for two days; this allows gravity to pull the particles away from the problem area.

The following self-help techniques may relieve or prevent the symptoms of vertigo:

* Sleep with your head slightly elevated on two or more pillows.

* In the morning, get up slowly and sit on the edge of the bed for a minute before standing.

* Avoid bending down to pick up items.

* Avoid extending your neck, for example, while reaching up to a high shelf.

* Move your head gently and slowly when at the dentist, hairdresser, or during activities where your head is lying flat (horizontal) or the neck is extended.

Diet

Avoid foods containing high sugar or salt content. Foods with complex carbohydrates with lower glycaemic index, such as legumes and whole grains are better choices.

Drink adequate amounts of fluid daily. Avoid foods and beverages with caffeine. Limit your alcohol consumption.

Avoid aspirin and non-steroid anti-inflammatory drugs such as brufen, voltaren.

Avoid nicotine

When you suffer from BPPV you must see your doctor first. He will do certain investigations to rule out other conditions that cause vertigo. Correct assessment and diagnosis are most important.

The treatment is not difficult but it should be demonstrated and taught by a trained medical professional, as it must be done properly in order to be effective.

Ref: Brochure on BPPV prepared by Kathee De Lapp, St. Vincents Hospital, Sydney www.nim.nih.gov/medlineplus

Sri Lanka now owns comprehensive data base on adolescent smoking habits

P. Wijesiri Gunasekara, National Coordinator, GYTS/WHO

SMOKING HABITS: Tobacco use is one of the major preventable causes of premature death and diseases in the world.

The World Health Organisation (WHO) attributes over 5 million deaths a year to tobacco use, a figure which is expected to rise to 10 million deaths a year by 2030. Seventy per cent of these deaths will occur in developing countries.

Globally, one person dies every 6.5 seconds of a tobacco related disease and tobacco consumption is on the increase. Given the current pattern of tobacco use globally, it is estimated that 250 million children and adolescents who are alive today will die prematurely because of tobacco, most of them in developing countries.

In our neighbouring country, India, tobacco is estimated to cause 800,000 deaths annually.

A large body of researches in the developing world shows that most of the adults who use tobacco at present have initiated their smoking habits at their teens.

A large volume of researches are available in USA which shows that nearly nine out of ten current adult smokers (89 per cent) started their smoking habits before they reach 19 years of age.

Even limited research findings available in developing world on the subject show, that the initiation of tobacco related products is occurred before the smokers reach 18 years of age.

If this pattern continues in the developing countries, tobacco use will result in the death of 250 million people who are children and adolescents living today.

As far as the developing countries are concerned, until recent times, a lack of research findings created a greater barrier in estimating the magnitude of the problem of adolescent tobacco use.

Even the limited research information available in the field did not provide a sufficient ground to make comparisons with the information available in the developed world, due to the fact that the researchers have followed different methodologies in conducting their researches.

In order to combat the rapid spread of the tobacco epidemic among adolescent age children and to help countries all over the world to plan and implement policies and programmes to control youth tobacco use, the Tobacco Free Initiative of WHO in collaboration with the Office on Smoking and Health (OSH), Centres for Disease Control (CDC) USA, developed the GYTS.

The GYTS uses a common methodology, core questionnaire, and consistent data processing for all countries. GYTS is a school based survey conducted among students studying in grades corresponding to ages 13-15 years.

In Sri Lanka, this included Grades 8-10 in Government and private schools. The GYTS has been conducted in 139 countries and has been repeated at least once in 31 countries across all six WHO regions.

GYTS includes data on prevalence of cigarettes and other tobacco use, perception and attitudes concerning tobacco use as well as information on access, availability and price, exposure to environment tobacco smoke (ETS), school curriculum, media and advertising and cessation.

Data from the GYTS can be used to help countries develop, implement and evaluate comprehensive tobacco control programmes.

Sri Lanka was privileged to have its opportunity to become one of the seven original countries which conducted the GYTS in 1999 along with Barbados, China, Costa Rica, Jordan, Russia, Venezuela. A repeat survey was done in 2003.

Sri Lankan GYTS were school based surveys of students attending grades 8-10 corresponding to the age group 13 to 15, using a standardised methodology.

Both surveys were conducted with an anonymous, self-administered close ended questionnaire. The questionnaire had 55 core questions and was pilot tested before it was administered in 1999; the same questionnaire was used in 2003.

In 1999 as well as in 2003, a two stage cluster sample design was used to produce representative data for the entire country.

At the first stage, schools were selected with probability proportional to enrolment size. At the second stage, classes were randomly selected and all students in selected classes were eligible to participate.

In 1999, the school response rate was 85.7 per cent, the student response rate was 89.0 per cent and the overall response rate was 76.4 per cent (school - student). A total of 2,896 students participated in the 1999 survey.

In 2003, the school response rate was 100 per cent, the student response rate was 79.1 per cent and the overall response rate was 79.1 per cent. For the 2003 survey, 1,845 students participated.

The GYTS was administered during one class period, i.e. second period of the day, and the procedures were designed to protect student privacy by assuring that their participation was anonymous and voluntary.

Before the surveys were administered concurrence of the education authorities, directorate, school heads and the parents of participating students was obtained.

Acne - In and out

Dr. Sharnika Abeykirthi, Senior Registrar Dermatology Unit NHC

Continued from last week

What are the different types of acne?

Chloracne

These patients present with multiple comedones. This is due to exposure to certain toxics, chlorinated hydrocarbons etc.

Cosmetic acne

This type of acne is seen in females, especially those who had acne in their adolescence and have used cosmetics for a long time. Sometimes when you start using a newer cosmetic which is comedogenic, you will notice a flare up acne.

Pomade acne

Greasy preparations used to defreeze curly hair can cause acne specially comedones around the forehead.

Mechanical acne

This type of acne occurs at the site of physical trauma. eg. At the chin of violin players, due to the friction of head bands, tight bra straps.

If you have acne together with excessive hair on your face.

In this context, you should consult a doctor, especially if you are abnormally fat or have menstrual irregularities, because you may be having an underlying endocrine disorder. There are certain diseases that can mimic acne. eg. Rosacea. Your doctor will be able to differentiate these conditions.

Why you should take acne seriously and seek treatment early?

Because it is no longer a common natural thing that can occur to most of us during our adolescence. It is a disease that can end up in permanent disfigurement due to pigmentation, scarring and keloid formation.

If you seek treatment early, the disease can be cured and prevent complications. So you should not hesitate to go to a doctor for treatment early because there are number of treatment modalities available for acne now.

Some myths about acne Acne is infectious

Some people believe that by kissing a person who has acne, sharing the same towel can cause acne. This is not true. Although acne is cause by a bacteria it is not infectious.

Eating oily foods can cause acne Increased sebum or oil secretion by sebaceous glands cause acne. But oily foods only increase your blood lipid levels and these lipids do not pass into the sebaceous glands. So oily foods cannot cause acne. Acne patients needs to wash to their skin thoroughly and frequently.

Many people believe that acne is related to poor hygiene. So they wash their face excessively and frequently.

But there is no evidence that lack of washing is associated with acne or frequent washing improves the condition. But of course if you wear make up, it is important to wash them off as soon as possible.

How do you manage acne?

Management of acne depends on your age, sex, type of acne and its severity.

General measures

Diet: As I have mentioned earlier eat anything in moderate amounts is the best advice one can give.

Skin care

Patients should cleanse their acne skin areas twice daily with medicated antiacne soap. Avoid rough clothes and other scrubbing materials. Acne patients should cleanse their skin gently. Moisturizers can be useful for people with dry skin.

In addition, acne patients should use noncomedogenic skin care products and cosmetics.

In general lotions and oilbased products are more comedogenic than gel based products.

(Treatment methods next week)